Biomechanical and Biologic Augmentation for the Treatment of Massive Rotator Cuff Tears (original) (raw)

Treatment options for massive rotator cuff tears: a narrative review

Acta Bio Medica : Atenei Parmensis, 2021

The treatment of massive rotator cuff tears poses a challenge to orthopedic surgeons. The prevalence of massive rotator cuff tears is 40% of all rotator cuff tears. Compared with smaller tears, massive rotator cuff tears are often complicated by structural failure and poor outcomes and present a higher rate of recurrent tearing after surgical repair. Several management options are available but the selection of the most appropriate treatment for each patient can be challenging. To achieve the best outcomes, the orthopedic surgeon should have a good understanding of the indications, the pathomechanics and the clinical outcomes of the various treatment modalities. Treatment options include non-operative management, arthroscopic debridement with a biceps tenotomy or tenodesis, complete or partial repair, patch augmentation, superior capsular reconstruction, muscle/tendon transfer and reverse total shoulder arthroplasty. The purpose of this article is to review treatment options and cli...

An Update on Surgical Management of the Repairable Large-to-Massive Rotator Cuff Tear

Journal of Bone and Joint Surgery, 2020

ä Despite an evolving array of surgical options and technologies available to perform rotator cuff repair, as well as advances in postoperative rehabilitation strategies, reported failure rates remain high, with large-to-massive rotator cuff tears showing higher failure rates than small-to-medium-sized tears. ä Preoperative magnetic resonance imaging is critical for judging the potential repairability of a large-to-massive rotator cuff tear based on imaging characteristics, including tear size and retraction, length and attenuation of the tendon stump, and fatty infiltration or atrophy in the rotator cuff muscle bellies. Advanced fatty infiltration and atrophy in the rotator cuff muscles have been found to be independent predictors of retear following repair of largeto-massive tears. ä While there is some evidence that double-row rotator cuff repairs have lower failure rates for larger tears, a doublerow repair may not always be possible in some chronic, retracted large-to-massive rotator cuff tears that cannot be completely mobilized and have tendon loss. ä Strategies to augment rotator cuff repairs are based on the desire to improve the mechanical integrity and biologic healing environment of the repair, and they have shown promise in improving healing rates following repair of largeto-massive tears. ä While most patients report pain relief and have increased patient-reported outcomes scores after surgery, studies have shown that patients with an intact repair have better functional scores, range of motion, and strength, and less fatty degeneration compared with patients with a failed repair. Surgical repair of rotator cuff tears (RCTs) is an increasingly common orthopaedic procedure, with the number of surgeries performed yearly exceeding 250,000 in the United States 1-3. Despite expanding surgical options and technologies to perform repair, and advances in postoperative rehabilitation strategies, reported failure rates remain high, with at least 20% to 30% of all rotator cuff repairs showing evidence of retear and failure rates ranging from 0% to 94% across clinical studies 4-10. Treatment of repairable RCTs is a complex decision-making process based on patient symptoms and expectations, as well as characteristics of the RCT, including tear acuity, tear pattern, and other imaging findings. While the majority of patients report pain relief and have increased patient-reported outcome measures (PROMs) after surgery regardless of the structural integrity of the repair 11,12 , studies have shown that patients with an intact repair have better functional scores 13-19 , range of motion 6,19-22 and strength 6,15,16,19-24 , and less fatty degeneration 19 compared with patients with a failed repair 9. There is wide variability in patient response to rotator cuff repair, but Disclosure: The authors indicated that no external funding was received for any aspect of this work. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked "yes" to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work and "yes" to indicate that the author had a patent and/

Massive rotator cuff tears: The result of partial rotator cuff repair

Journal of Shoulder and Elbow Surgery, 2005

Massive rotator cuff tears often defy traditional repair techniques and have led to a variety of treatment recommendations. We reviewed retrospectively the results of partial repair of massive rotator cuff tears in 24 patients. Overall results were excellent in 11 patients (46%), good in 5 (21%), fair in 7 (29%), and poor in 1 (4%). Ninety-two percent of patients were satisfied with the result of surgery. Satisfactory pain relief was achieved in 83% (P Ͻ .001). Active elevation improved from 114°to 154°, and no patient lost strength after surgery. The ability to raise the arm to at least 135°improved from 13 patients preoperatively to 21 patients postoperatively. This series serves as a basis of comparison to debridement, tendon transfers, and tendon augmentation procedures for the treatment of massive irreparable rotator cuff tears.

The Clinical and Structural Long-Term Results of Open Repair of Massive Tears of the Rotator Cuff

The Journal of Bone and Joint Surgery (American), 2008

Permissions] link. and click on the [Reprints and jbjs.org article, or locate the article citation on to use material from this order reprints or request permission Click here to Background: At a mean follow-up of 3.1 years, twenty-seven consecutive repairs of massive rotator cuff tears yielded good and excellent clinical results despite a retear rate of 37%. Patients with a retear had improvement over the preoperative state, but those with a structurally intact repair had a substantially better result. The purpose of this study was to reassess the same patients to determine the long-term functional and structural results.

Rotator cuff tear: A detailed update

Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology, 2015

Rotator cuff tear has been a known entity for orthopaedic surgeons for more than two hundred years. Although the exact pathogenesis is controversial, a combination of intrinsic factors proposed by Codman and extrinsic factors theorized by Neer is likely responsible for most rotator cuff tears. Magnetic resonance imaging remains the gold standard for the diagnosis of rotator cuff tears, but the emergence of ultrasound has revolutionized the diagnostic capability. Even though mini-open rotator cuff repair is still commonly performed, and results are comparable to arthroscopic repair, all-arthroscopic repair of rotator cuff tear is now fast becoming a standard care for rotator cuff repair. Appropriate knowledge of pathology and healing pattern of cuff, strong and biological repair techniques, better suture anchors, and gradual rehabilitation of postcuff repair have led to good to excellent outcome after repair. As the healing of degenerative cuff tear remains unpredictable, the role of biological agents such as platelet-rich plasma and stem cells for postcuff repair augmentation is still under evaluation. The role of scaffolds in massive cuff tear is also being probed.

Irreparable rotator cuff tears: challenges and solutions

Orthopedic Research and Reviews

Irreparable rotator cuff tears are common conditions seen by shoulder surgeons, characterized by a torn and retracted tendon associated with muscle atrophy and impaired mobility. Direct fixation of the torn tendon is not possible due to the retracted tendon and lack of healing potential which result in poor outcome. Several treatment options are viable but correct indication is mandatory for a good result, pain improvement, and restoration of shoulder function. Patient can be treated either with a conservative program or surgically when necessary, by different available modalities like arthroscopic debridement, partial reconstruction, subacromial spacer, tendon transfer, and shoulder replacement with reverse prosthesis. The aim of this study was to review literature to give an overview of the available possible solutions, with indications and expected outcomes.

Clinical and biological aspects of rotator cuff tears

Muscles, ligaments and tendons journal, 2013

Rotator cuff tears are common and are a frequent source of shoulder pain and disability. A wide variation in the prevalence of rotator cuff tears has been reported. The etiology of rotator cuff tear remains multifactorial and attempts to unify intrinsic and extrinsic theories tried to explain the etiopathogenesis of rotator cuff tears. Knowledge of the etiopathogenesis of rotator cuff tears is important to improve our therapies, surgical techniques and promote tendon repair. Several strategies have been proposed to enhance tendon healing and recently research has focused on regenerative therapies, such as Growth Factors (GFs) and Plasma Rich Platelet (PRP), with high expectations of success.